Provider Demographics
NPI:1386941680
Name:JOHNSTON, JENNIFER STELLFOX (PHARMD, RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:STELLFOX
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2535
Mailing Address - Country:US
Mailing Address - Phone:864-297-0739
Mailing Address - Fax:864-279-1839
Practice Address - Street 1:104 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2535
Practice Address - Country:US
Practice Address - Phone:864-297-0739
Practice Address - Fax:864-279-1839
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC010357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist